Chapter 743  Health and Life Insurance

General Provisions

§ 743.010 Health insurance policy and health benefit plan forms
§ 743.013 Disclosure of differences in replacement health insurance policies
§ 743.015 Filing and approval of credit life and credit health insurance forms
§ 743.018 Filing of rates for life and health insurance
§ 743.019 Public comment on proposed rates for health insurance
§ 743.020 Rate filing to include statement of administrative expenses
§ 743.024 Personal insurance, insurable interest and beneficiaries
§ 743.027 Consent of individual required for life and health insurance
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Policy Language Simplification

§ 743.100 Short title
§ 743.101 Purpose
§ 743.103 Definitions for ORS 743.100 to 743.109
§ 743.104 Scope of ORS 743.100 to 743.109
§ 743.106 Reading ease standards for life and health insurance policies
§ 743.107 When director may authorize lower standards
§ 743.109 Approval of certain policy forms containing specified provisions

Individual Life Insurance And Annuities

(Generally)

§ 743.150 Scope of ORS 743.150, 743.153 and 743.156
§ 743.153 Statement of benefits
§ 743.154 Acceleration of death benefits
§ 743.156 Statement of premium

(Individual Life Insurance Policies)

§ 743.159 Scope of ORS 743.162 to 743.243
§ 743.162 Payment of premium
§ 743.165 Grace period
§ 743.168 Incontestability
§ 743.171 Incontestability and limitation of liability after reinstatement
§ 743.174 Entire contract
§ 743.177 Statements of insured
§ 743.180 Misstatement of age
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(Individual Annuity And Pure Endowment Policies)

§ 743.252 Scope of ORS 743.255 to 743.273
§ 743.255 Grace period for annuities
§ 743.258 Incontestability
§ 743.261 Entire contract
§ 743.264 Misstatement of age or sex
§ 743.267 Dividends
§ 743.268 Advancement of policy loans
§ 743.269 Periodic payments for period certain
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Group Life Insurance

§ 743.303 Requirements for issuance of group life insurance policies
§ 743.306 Required provisions in group life insurance policies
§ 743.309 Nonforfeiture provisions
§ 743.312 Grace period
§ 743.315 Incontestability
§ 743.318 Application
§ 743.321 Evidence of insurability
§ 743.324 Misstatement of age
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Credit Life And Credit Health Insurance

§ 743.371 Definitions for credit life and credit health insurance provisions
§ 743.372 Applicability of credit life and credit health insurance provisions
§ 743.373 Forms of credit life and credit health insurance
§ 743.374 Limits on amount of credit life insurance
§ 743.375 Limit on amount of credit health insurance
§ 743.376 Duration of credit life and credit health insurance
§ 743.377 Credit life and credit health insurance policy or group certificate
§ 743.378 Charges and refunds to debtor
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Health Insurance

(Individual)

§ 743.402 Exceptions to individual health insurance policy requirements
§ 743.405 General requirements for health insurance policies
§ 743.408 Mandatory provisions
§ 743.411 Entire contract
§ 743.414 Time limit on certain defenses
§ 743.417 Grace period
§ 743.420 Reinstatement
§ 743.423 Notice of claim
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(Group And Blanket)

§ 743.522 Additional groups designated by director
§ 743.523 Certain sales practices prohibited
§ 743.524 Eligibility of association to be group health policyholder
§ 743.526 Determination of whether trustees are policyholders
§ 743.527 When group health insurance policies to continue in effect upon payment of premium by insured individual
§ 743.528 Required provisions in group health insurance policies
§ 743.529 Continuation of benefits after termination of group health insurance policy
§ 743.530 Continuation of benefits after injury or illness covered by workers compensation
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(Continuation)

§ 743.600 Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older
§ 743.601 Procedure for obtaining continuation of coverage under ORS 743.600
§ 743.602 Premium for continuation of coverage under ORS 743.600
§ 743.610 Continuation of coverage under group policy upon termination of membership in group health insurance policy

(Long Term Care)

§ 743.650 Long Term Care Insurance Act
§ 743.652 Definitions for ORS 743.650 to 743.665
§ 743.653 Prohibition on certain policies
§ 743.655 Rules
§ 743.656 Eligibility for benefits
§ 743.662 Rescission of policy and denial of claims
§ 743.664 Offer of nonforfeiture benefit
§ 743.665 Prompt pay requirements

(Medicare Supplement)

§ 743.680 Definitions for ORS 743.680 to 743.689
§ 743.682 Application of ORS 743.680 to 743.689
§ 743.683 Policy contents
§ 743.684 Filing of policy
§ 743.685 Outline of coverage
§ 743.686 Right to return of policy
§ 743.687 Advertising
§ 743.688 Rules
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(Small Employer, Group, Individual And

Portability Health Insurance, Generally)

§ 743.730 Definitions for ORS 743.730 to 743.773
§ 743.731 Purposes
§ 743.733 Issuance of group health benefit plan to affiliated group of employers
§ 743.734 Group health benefit plans subject to provisions of specified laws
§ 743.736 Requirement to offer all health benefit plans to small employers
§ 743.737 Requirements for small employer health benefit plans
§ 743.745 Requirements for health benefit plans
§ 743.748 Submission of information by carriers offering health benefit plans
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Miscellaneous

§ 743.801 Definitions
§ 743.803 Medical services contract provisions
§ 743.804 Required notices to applicants and enrollees
§ 743.806 Utilization review requirements for medical services contracts to which insurer not party
§ 743.807 Utilization review requirements for insurers offering health benefit plan
§ 743.808 Requirements for insurers that require designation of participating primary care physician
§ 743.811 Applicability
§ 743.814 Requirements for insurers offering managed health insurance
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Rights Of Enrollees

§ 743.845 Designation of womens health care provider as primary care provider
§ 743.847 Medicaid not considered in coverage eligibility determination
§ 743.854 Continuity of care
§ 743.856 Referrals to specialists
§ 743.857 External review
§ 743.858 Director to contract with independent review organizations to provide external review
§ 743.859 Notice to enrollee of right to sue if insurer does not follow decision of independent review organization
§ 743.861 Enrollee application for external review
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Payment Of Claims

§ 743.911 Payment or denial of health benefit plan claims
§ 743.912 Refund of paid claims
§ 743.913 Interest on unpaid claims
§ 743.917 Underpayment of claims
§ 743.918 Claims submitted during credentialing period
§ 743.921 Payment of ambulatory surgical center claims

Risk Adjustment Procedures

§ 743.923 Risk adjustment procedures

Assessment On Premiums Or Claims

§ 743.951 Payment procedures
§ 743.960 Definitions for ORS 743.960 and 743.961
§ 743.961 Payment procedures
§ 743.965 Incorrect payments
§ 743.990 Penalties